Prevalence and predictors of decisional conflict among older African Americans with advanced chronic kidney disease

Abstract Background and Objectives Decisional conflict (DC), or uncertainty about health-related decisions, is common among individuals with advanced chronic kidney disease (CKD), yet little is known about its prevalence and predictors among older African Americans, a population disproportionately affected by CKD. This study examined the prevalence of DC and how personal characteristics, perceived kidney disease knowledge, and clinical factors are associated with DC in this group. Research Design and Methods This was a cross-sectional study involving 125 African American adults aged 50 and older with Stage 4 or 5 CKD who had not yet started dialysis. Participants completed structured telephone interviews to assess DC (Decisional Conflict Scale), perceived CKD knowledge, depressive symptoms, anxiety, comorbidities, and sociodemographic factors. Hierarchical multiple regression analyses were performed to identify predictors of DC. Results Participants reported moderate levels of DC (M = 36.69, SD = 23.2), with approximately 42% scoring above the threshold indicating decisional difficulty. In multivariate analyses, perceived CKD knowledge was the only significant predictor of DC (β = −0.58, p < .001), accounting for a substantial proportion of variance. Personal and clinical characteristics were not significant in the final model. Discussion and Implications Findings highlight the crucial role of perceived knowledge in shaping decision-making among older African Americans with advanced CKD. Interventions that improve disease-specific knowledge during the pre-dialysis period may reduce decisional conflict and promote informed, patient-centered care. Future research should explore tailored educational strategies and structural factors affecting decision-making in this population.